Nevirapine

What nevirapine is and how it works

Nevirapine is a prescription antiretroviral medicine used, always together with at least two other antiretroviral medicines, to treat HIV-1 infection. It belongs to a class called NNRTIs (non-nucleoside reverse transcriptase inhibitors), which block an enzyme HIV needs to copy itself. (1)

Nevirapine carries two genuine, serious boxed warnings: a real risk of life-threatening liver injury, and a real risk of severe, sometimes life-threatening skin reactions (including Stevens-Johnson syndrome). Both risks are highest in the first 6 to 18 weeks of treatment, which is why treatment always starts at a lower dose for the first 14 days and why regular liver blood tests and close monitoring for rash are part of safe treatment from the very first dose.

Mechanism of action: how nevirapine works

Nevirapine is a non-nucleoside reverse transcriptase inhibitor (NNRTI). It binds directly to HIV-1 reverse transcriptase and blocks the RNA- and DNA-dependent DNA polymerase activities of the enzyme, disrupting the catalytic site needed for viral replication. It is not active against HIV-2. Resistant virus emerges rapidly if nevirapine is used as monotherapy, so it must always be combined with other antiretroviral agents. (1) (3)

What nevirapine is used for

Before taking nevirapine

Do not take / not appropriate for

• Do not take nevirapine if you have moderate or severe liver impairment (Child-Pugh Class B or C). (all countries) (1) (3)
• Do not take nevirapine if you previously had to stop it because of a severe rash, hypersensitivity reaction, or liver reaction linked to nevirapine. (United States) (1)
• Do not take nevirapine as your only HIV medicine -- it must always be combined with at least two other antiretroviral medicines. (all countries) (6)
• Discuss with your prescriber before starting nevirapine if you are an adult woman with a CD4+ count above 250 cells/mm3, or an adult man with a CD4+ count above 400 cells/mm3 -- nevirapine is generally avoided in these situations unless your prescriber judges the benefit clearly outweighs the substantially higher liver-injury risk. (all countries) (1) (3)

Tell your clinician about

• Any history of liver disease, hepatitis B or C, or abnormal liver blood tests.
• Your current CD4+ cell count, since this affects your starting risk of liver injury.
• All other medicines, especially rifampin/rifampicin, hormonal contraceptives, and other HIV medicines (particularly protease inhibitors).
• Whether you are pregnant, plan to become pregnant, or are breastfeeding.
• Any previous allergic reaction or severe rash with nevirapine or other antiretroviral medicines.

How to take nevirapine

• Always taken together with at least two other antiretroviral medicines, exactly as your prescriber directs.
• Treatment starts with a lower once-daily dose for the first 14 days (the 'lead-in period'), which has been shown to reduce the frequency of rash, before increasing to the full twice-daily dose.
• If treatment is interrupted for more than 7 days, the 14-day lead-in period must be restarted under your prescriber's direction before returning to the full dose.
• Extended-release tablets must be swallowed whole -- do not chew, crush, or divide them.

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6)

Missed dose

Contact your prescriber or HIV care team for guidance if you miss a dose, especially during the 14-day lead-in period -- do not double a dose or change your schedule on your own, since correct timing is part of how this medicine's risks are managed safely.

Overdose

Seek urgent medical attention if you think too much nevirapine has been taken, or if you develop any signs of a severe skin reaction, jaundice (yellowing of the skin or eyes), or severe illness. (1)

Side effects

Side effects and their urgency vary; report severe, persistent, or concerning symptoms.

Serious warnings

Interactions

• Rifampin/rifampicin (a tuberculosis antibiotic): should not be given together with nevirapine, since it substantially reduces nevirapine levels and effectiveness. (1) (3)
• Hormonal contraceptives (such as ethinyl estradiol/norethindrone-containing pills): nevirapine can lower their blood levels and effectiveness; an additional or alternative non-hormonal contraceptive method is recommended. (1) (3)
• Certain other HIV medicines, especially protease inhibitors (such as atazanavir, indinavir, and lopinavir): substantial interactions exist, and dose adjustments are often needed -- your HIV specialist will manage your full combination regimen. (1) (3)

Pregnancy, breastfeeding, kidney/liver function, age

Monitoring

Before starting

• Baseline liver function tests
• Current CD4+ cell count
• Review of other medicines for interactions (rifampin/rifampicin, hormonal contraceptives, protease inhibitors)

During treatment

• Liver function tests at baseline, before dose escalation, and at regular intervals during the first 18 weeks (specific schedules vary slightly by source, generally every 2-3 weeks for the first 1-3 months, then monthly).
• Close monitoring for rash or other skin changes, especially during the first 6 weeks.
• Immediate liver function testing if a rash develops in the first 18 weeks of treatment.
• Ongoing clinical monitoring for signs of hypersensitivity syndrome (fever, malaise, organ involvement) alongside any skin changes.

Storage

Store at room temperature, protected from moisture and light, out of reach of children.

Frequently asked questions

References

1. VIRAMUNE (nevirapine) tablet -- full prescribing informationU.S. Food and Drug Administration / DailyMed (NIH), full prescribing information, Boehringer Ingelheim · United States · dated 2026-01-01 · accessed 2026-07-30 · source 1
2. Nevirapine 200mg Tablets -- Summary of Product Characteristics (SmPC)electronic medicines compendium (emc), United Kingdom -- Summary of Product Characteristics · United Kingdom · dated 2025-01-01 · accessed 2026-07-30 · source 2
3. Viramune (nevirapine) -- EPAR product information (Summary of Product Characteristics)European Medicines Agency (EMA) -- centralised European Public Assessment Report (EPAR) and product information · European Union · dated 2026-01-01 · accessed 2026-07-30 · source 3
4. VIRAMUNE (nevirapine) -- Product MonographHealth Canada -- Product Monograph (Viramune, nevirapine) · Canada · dated 2020-01-01 · accessed 2026-07-30 · source 4
5. VIRAMUNE / VIRAMUNE XR (nevirapine) -- ARTG entries 72099 and 176980Therapeutic Goods Administration (TGA), Australia -- Australian Register of Therapeutic Goods (ARTG) and PBS · Australia · dated 2026-04-01 · accessed 2026-07-30 · source 5
6. Viramune (nevirapine) tablets and oral suspension -- New Zealand Data SheetMedsafe (New Zealand Medicines and Medical Devices Safety Authority) -- New Zealand Data Sheet · New Zealand · dated 2025-01-01 · accessed 2026-07-30 · source 6

Brand names by country

Single-ingredient nevirapine names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries